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On today’s episode, we get an inside look at injury management at the NBA level. Maggie shares important factors to consider when an injury occurs and details the return-to-performance system she uses to help athletes return to the court with confidence. Using an example injury, we cover the different phases of this system and how Maggie combines objective and subjective data to drive decision-making.
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Welcome to the Keiser Human Performance Podcast.
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The goal of this podcast. is to educate and inspire you to make the most of your
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journey in health and
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performance. Each episode will provide an in-depth discussion on a specific topic related to human performance.
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If you're a growth-minded
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individual seeking knowledge and better solutions,
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this podcast is for you. We're glad you're listening in, and we're excited to learn alongside
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you. My name is Gabe German, and today I'm joined by Maggie
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Bryant. A doctorate of physical
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therapy, Maggie's the vice president of medical for the NBA's Los Angeles Clippers.
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She arrived in LA after having spent time with the Orlando Magic,
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Mayo
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Clinic, and USC.
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On today's episode, we get an inside look at injury management at the NBA level. Maggie shares
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important factors to consider when an injury occurs, and details the return to performance.
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system she uses to help athletes return to the court
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with confidence. Using an example injury, we cover the different phases of this system and how Maggie combines
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objective and subjective data to drive decision-making.
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The best place to follow Maggie is on X @Bryant5Maggie
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or on Instagram @magsb55.
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We hope you' enjoy today's episode.
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Hey, Maggie. Thank you. for joining me today. How you' doing?
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Good.
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How are you? I'm great. I'm great. I appreciate
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it. So, you. know, I had the opportunity to hear you speak at the 2023 High Performance Basketball Symposium
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down in Orlando. I enjoyed the content
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of your presentation, and in addition to that, you know,
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we've had Todd Wright on an, episode of our Keiser Education Series centered around building a high performance team.
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Obviously, you're a part of that high performance team, so I' think it was really the kind of the combination
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of those two things that really, you know, made me want to bring you
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on as a guest. So, I appreciate
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you being here today. Well, thank you for having me.
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No, I appreciate, uh, appreciate you, uh, for, again, having me and, and, you know, I've listened to other ones,
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and you do a really good job. So, excited- Well- ... to be a
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part of it. All
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right. Thank you. So, um, it's my understanding that you came from Mayo to the NBA' with the Orlando Magic.
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Is that right? Exactly,
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yep. So I'm curious what you remember about your first day' on the job in the NBA. Like, what was
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that experience like walking through, you know, in, in Orlando, walking through the doors and, and getting ready to start
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your
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career in the NBA? For sure.
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Um, just a whirlwind.
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You know, I think
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you,
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you go with some type of expectation of what any... with any job. You
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go and you expect, uh, or you try to kind of figure out what it's gonna be like, and
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then, you know, specifically in the NBA, every day is
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so different that you just go, try to navigate the space.
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And I, and I remember kind of walking in thinking, "All right, who is who? Where... You know, who...
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Where do
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I go? I'm a female. There's a lot of male spaces. Like, where's my space?" You know, just,
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just trying to figure out kind of the lay of the land
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and,
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and, you know, where I can succeed in my role and,
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um, you know, where I fit in that big
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staff, and it, it was a whirlwind for sure. And then
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I remember, um, hearing the schedule, 'cause obviously I joined in the summer, uh, or
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in the off season. Mm-hmm. So I remember hearing just the,
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the in-season schedule
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and thinking, "All
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right.
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Let's go."
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So it was a whirlwind ever
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from the start, but,
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um, it was fun. It was fun,
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so. So do you ever think about... I mean, now your current role, you have a lot more experience
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and, and you've kind of worked your way up to it as well at the same time. You've seen a
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lot more now. Do you ever kind of think about that day, reflect on that day? Oh, for sure.
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Like deer in the headlights. I look back and- ... kind of laugh at myself on how I handled certain
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things or how,
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um, yeah, just how, what my approach was and, and
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kind of just, you know, appreciate those times, but also probably learn some lessons along the way that,
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you
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know, um, would maybe have changed the way I would have done certain things or just, again, eye-opening, uh, experiences,
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but that's part of it. So, uh, it's fun to, it's fun to look back and to just remember
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thinking, uh, yeah, just how, how different everything was and exciting and scary and nerve-wracking. So it is, it is
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funny
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to think back. Yeah. We'll have some time later to ask about some of those things. I am curious
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about maybe some of the mistakes or things you might have done differently or, or, you know, things along those
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lines, so we'll definitely get to that. But, uh, I was thinking about your presentation in Orlando that I mentioned,
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and there was one slide early on that kind of stood out to me. It was a fairly simple
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slide, um, but it had a lot of these different factors that you consider when an injury occurs,
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like what, what your thought process is as you think about the return to performance protocol.
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And I remember kind of laughing to myself a little bit because I go to games with
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my friends and, and family, and I'm in Chicago. I listen to sports radio in Chicago, which is incredibly entertaining.
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Um, and, and you hear,
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you
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know, normal people, uh, who aren't involved in sports talk about, "Oh, why don't they
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just do this and do that,
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and he can come back
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from this" and, um, if they only knew
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really all of these things that you have to consider and what your process is
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like. So I guess if you could elaborate on what your process is when an injury happens,
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like, hey, injury has occurred. Maybe we're day zero or day one. What are these factors that you, that
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you have to consider? For sure. No, I think that's a good question. Um,
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you
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know, I think you, yeah, you kind of break it down, and I remember the slide you're referring
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to. Um, I think they specifically go into kind of the injury details, the athlete details, and then just the
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contextual factors, and it's really, really relevant in pro sports, some of those contextual factors and, and just the athlete
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specific, um, in addition to the injury. So, you know, an injury occurs. We first and foremost obviously want to
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stabilize the injury and then create some sort of diagnostic, um, exam or process and
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try- Mm-hmm ... to figure out, okay, what
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are we working with? What's the prognosis? What's the, what's the severity behind it? Um, and then-Again, just kinda manage
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that acute phase of, all right, what is the acute thing that we need to manage
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right now? Um, and then how do we... And then what's the, again, what's the
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prognosis? How, how long is
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this gonna be, you know, an issue? Is it gonna be a time-loss injury? Is it gonna be a we
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can
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maybe return today? Uh, and then just trying to work through
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those a little bit. Um, and then you look specifically athlete-to-athlete and try to gain,
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you know, some, some knowledge on, all right, what's this athlete's prior medical history, and is that relevant in this
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situation?
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What's their age? Where are they at in their playing career? Um, where are they at in the season? So
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obviously you look at, you know, some teams that have some big
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injuries right now, playoffs are five days from now, so all of a sudden your, your decision-making should stay pretty
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robust throughout it all,
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but it's gonna look a little different if it's playoffs or if it's five days before a training camp,
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it's gonna look a little different. So there's just a lot that goes into it. And then,
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you know, I think another factor that is really, really important in pro sports is just the importance of communication
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right away. So communication to all
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the stakeholders, the doctors, the athlete, the agent, and all the key stakeholders around that athlete,
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management,
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um, and making sure that message is aligned. Um, you know, and then again,
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just trying to manage, manage the big picture around it. So there's a lot that goes into, uh, any time
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a, a guy has an injury
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and, or a complaint and,
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um, it's pretty multifactorial,
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so. Yeah. I mean, one of the things that we had with Todd and, and Phil Coles
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over at the Boston Celtics would... They, they talked about the alignment part that you just
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hit on. Having a lot of voices behind closed doors and then really
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one, you know, coming out of that door.
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Absolutely.
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Absolutely. Which is- That's really important ... a key component.
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So, um, the contextual
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piece, uh, can you expand a little bit on that? I know you had mentioned injury factors and athlete details.
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What's this contextual piece, or what are factors that go underneath that umbrella? Yeah, for sure. So, you know,
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the contextual are gonna be anything that's gonna maybe modify the decision outside of the injury or the athlete.
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So- Okay ... um, I mean, it can be specific to the athlete, but, you know, are, are they
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on a contract
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year? Okay. That might dictate whether there's, you know, the level. of aggression to, of the athlete
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to return to play, um, or, or, you know, how, how conservative they want to approach it as
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well. Um,
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again, timing of the season, uh, standings.
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So, you know, if you're last place and you have 10 games left and you're not gonna make the playoffs,
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you're probably gonna make maybe a little bit
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of a decision, or you, you might be a little bit more conservative maybe, um, in some of that decision-
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Right ... versus if you're going to the playoffs, so some of those factors.
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And then just,
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you know, I think i- in, in our world, um, the pressure is really, really high for these players. And
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so even, you know, certain kind of effects like media, in the media and... or, you know, if an injury,
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if an athlete has repetitive injuries, how that media likes to spin it, and what that does to the, to
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the pressure of that athlete just from a mental standpoint. So a lot of, yeah, the contextual factors
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are, are
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very important when dec- making any kind of decision around return to play or prognosis or,
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or any of that, so. Yeah. I imagine that varies from organization to organization, too, about how they handle
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all of that, right? For sure. Yep. And from player to player and, yeah, absolutely.
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Yeah. So again, a,
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a really simple slide that was there,
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but you know, you put a couple things on there that really stood out to me, and I was like,
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"Yeah, okay, these are all the things that you really have to, you know, consider." So I definitely developed an
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appreciation for that. And then another thing that stood out to me, uh, as you continued that presentation was, uh,
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your framework for the return to play or return to performance protocols. And can you provide an overview on the
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different phases of your return to performance system, and then we can dive into each one with maybe a specific
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example of an injury? Yeah, absolutely.
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Yeah, so there's gonna be different kind of frameworks depending
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on, you know, who, who talks about it or which resource you use, but it's essentially the same. So your...
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You know, I always like to say phase one is kind of that protection phase. You're
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trying to stabilize that injury. So, you know, you, you want that tissue to begin that... And it, and it
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goes with the tissue healing timeframes as well, where it starts
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in that in- after an injury occurs, there's usually an inflammatory phase.
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Um, and during this phase, you just want to stabilize the tissue, so protect
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it, um,
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get some sort of baseline on what that
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tissue, um, needs, and then
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allowing, you
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know, some of the, some of the symptoms, subjective and objective
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symptoms like, um, soreness, swelling, stiffness, so using those to kinda guide that initial process. But there's usually a period
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of, you know, modifying
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load, uh, or offload,
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um, you know, and just, again, protection of the acute injury. That's kind of that initial phase. Um, and
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then the second phase
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is, you know, now that tissue's beginning to kind of, uh, it kinda goes with that, again, that tissue healing
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f- um, phase of that proliferation. So new cells start to come in. They try to replace those damaged cells.
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At this time, the tissues aren't quite as strong, um, as what it was prior to injury
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or what it's gonna be hopefully once it's matured. And so, you know, that second phase is about starting to
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build a foundation to that tissue, whatever it may be. Um, you know, and, and usually starting with low-level strengthening
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or kind of activation,
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um- Mm-hmm ... of specific muscles, uh,
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or joints,
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um, you know, normalization of things such as range of motion, of gait, ADLs,
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and that all kinda happens at the beginning of this phase. And a- again, as those new cells
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come in, uh, and they're weaker, you want to
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start to kinda utilize principles like the SAID principle,
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um, specific adaptation to imposed demand, or mechanical transduction, where the load that you apply is gonna help these new
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cells and these new structures
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to really align the way that they need to essentially.
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Um, and so- Mm-hmm ... it's important to get them out of the immobilization
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stays and
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s- stage and start to load it, but-You know, optimal load here and, and just being very cognizant of the
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fact that the tissue is
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still weaker, um, and it's not at full strength, so,
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you know, being intentional with some of that
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loading.
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Right. Um, and then as you progress, now you've created this foundation, you've started to kind of lay these new
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tissues, um, you know, in, again, all these different vectors, all these
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different, um, plane of motion. And then the tissue now is beginning to become more mature, and it's more durable,
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so now you can really, really start to strengthen and, and all the qualities associated with that.
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So strength, power, rate of force development, elastic
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recoil, um, the plyometrics,
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that's, that's all, you know, important in this phase.
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Um, as well as just the return- some of the return
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to play or, you know, some of the, the sport-specific, um, progressions
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as well. And then, yeah, that fourth stage
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is building on the third. So, you know, continuing to kind of, um, kind of
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strengthen what you had from the third, so it's whether it's the power, the strength, and trying to just
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kind of clean those up and then promote them going
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into the fourth. Uh, and then
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in addition just, you know, introducing the return to play continuum. So, uh, return to performance, return
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to, return to sport, return to participation. Return to performance is, um, return to sporting drills. Return to sport is
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actually returning to that sport, and then return to performance is when you get those metrics back.
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So,
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um, that's kind of the whole-
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Yeah.
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No, I appreciate you laying
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that out, and I think, I think it's important to understand
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with
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that, you had this marriage of
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medical, S
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and C, and the on-court kind of throughout the entire time,
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maybe s- less in phase one,
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but can you maybe talk about the relationship of those? Those are kind of changing throughout each phase,
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right? As you progress from phase one down
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to phase four, you're able to maybe change the allotment of time for that athlete between the three of
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those. Is that right?
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For sure. Yep, for sure. Yeah,
00:14:13.152 --> 00:14:16.152
so, uh, early phases it's gonna be heavily medically driven.
00:14:16.492 --> 00:14:21.162
Um, you know, again, the, the main priority is protection and then start to lay the foundation
00:14:21.192 --> 00:14:26.792
of what we want to- the tissue to, you know, align to and, and to strengthen. So, you know, early
00:14:26.872 --> 00:14:27.022
on
00:14:27.052 --> 00:14:30.332
it's gonna be, again, heavily medical driven. Um,
00:14:30.872 --> 00:14:30.992
and
00:14:31.052 --> 00:14:36.862
then, you know, s- S and C and, and the on-court progression as well is gonna be really important. The
00:14:37.012 --> 00:14:37.032
S
00:14:37.052 --> 00:14:43.072
and C from, you know, offloaded conditioning, uh, strength, making sure the rest of the system is, is functioning
00:14:43.092 --> 00:14:45.112
at a high level. And then on court it's,
00:14:45.852 --> 00:14:48.062
you know, it's probably the least amount
00:14:48.172 --> 00:14:53.052
of times- Right ... but it's still, for these players or for these athletes, um, it's important a lot
00:14:53.072 --> 00:14:57.952
of times to also just have that sport still be a part of their process just from a mental standpoint.
00:14:58.052 --> 00:15:00.252
So- Sure ... you know, you find whatever
00:15:00.272 --> 00:15:01.992
their tol- tolerance is,
00:15:02.092 --> 00:15:04.052
you go right, you know, you find right below that
00:15:04.112 --> 00:15:05.972
and you, whether it's ball handling, form
00:15:06.032 --> 00:15:09.062
shooting, passing in a chair if you're offloaded, you know. And just,
00:15:09.872 --> 00:15:11.112
again, it's, it's just more
00:15:11.152 --> 00:15:12.002
mental. Um,
00:15:12.452 --> 00:15:17.052
and then as you progress throughout those phases, you know, once that tissue starts to mature
00:15:17.072 --> 00:15:22.512
and starts to become stronger, and then the majority of the time and effort is gonna be driven in the
00:15:22.532 --> 00:15:27.002
weight room and on court, where you're trying to build that load capacity. You're trying to strengthen the tissue and,
00:15:27.532 --> 00:15:28.252
and all the qualities
00:15:28.292 --> 00:15:33.082
that come with it. And then, um, medical's just kind of a guidance at this point. You know, reassess,
00:15:33.512 --> 00:15:34.212
you know, assessments,
00:15:34.272 --> 00:15:38.002
reassessments, um, guiding some of the on-court, guiding some of the, the
00:15:38.072 --> 00:15:41.112
weight room, uh, whatever treatment modalities.
00:15:41.272 --> 00:15:46.552
And then, s- and same thing, that kind of just continues to progress, so it's kind of, um,
00:15:46.572 --> 00:15:51.072
you know, on-court becomes much more of a priority and, and the weight room becomes a priority at the end.
00:15:51.532 --> 00:15:54.092
Beginning, it's more medical. They're all involved throughout the entire
00:15:54.172 --> 00:15:59.832
process, it's just, um, you know, shifts, I guess, shifts the importance a little bit. Yeah. It seems as though
00:15:59.872 --> 00:16:04.102
these act more as dimmers versus on/off switches, right? For sure. Yep. Yeah. For sure.
00:16:05.352 --> 00:16:05.942
And my,
00:16:06.132 --> 00:16:09.992
my head went immediately to form shooting, right? When you think about, like, a lower body
00:16:10.032 --> 00:16:14.372
injury, and that goes back to actually some of the athlete factors that you had mentioned earlier, right? Understanding these
00:16:14.452 --> 00:16:18.392
athletes, understanding who they are. Is this someone who needs to be engaged? If they, if they get too far
00:16:18.452 --> 00:16:23.512
away, does that start to do some damage, right? Um, where are they at from also a mental state? So,
00:16:23.612 --> 00:16:28.652
um- Yep ... I, I like the appreciation for that. And, um, maybe we can now go through each of
00:16:28.692 --> 00:16:29.152
these phases
00:16:29.172 --> 00:16:34.022
that you had mentioned, uh, with the context of, you know, an injury or through the lens of an actual
00:16:34.052 --> 00:16:37.212
injury. So, um- Sure ... let's, let's go with a right calf
00:16:37.272 --> 00:16:39.312
injury. Um, they, they seem to be happening
00:16:39.872 --> 00:16:41.112
you know, a lot, and,
00:16:41.232 --> 00:16:45.112
um, in the NBA, and I know that's really a sensitive topic and, and something
00:16:45.152 --> 00:16:49.112
that people like to be in the know and, and are constantly trying to figure out how we can reduce,
00:16:49.152 --> 00:16:54.312
you know, the rate of injury with the calf. So let's go with, like, a mild right calf injury here.
00:16:54.412 --> 00:16:57.032
Um, starting from the beginning, what's the assessment process like
00:16:57.072 --> 00:17:03.632
to determ- to determine the, uh, severity of the injury for you? Yeah, absolutely. So, you know, I- when you
00:17:03.672 --> 00:17:08.271
go back to kind of what in the initial phase you're assessing, so you're assessing
00:17:08.352 --> 00:17:14.291
their, uh, ability to stretch through that tissue, so their stretch tolerance. Um,
00:17:14.592 --> 00:17:16.271
you know, first and foremost, is it
00:17:16.872 --> 00:17:17.291
more
00:17:17.672 --> 00:17:19.992
soleus or gastroc kind of component?
00:17:20.082 --> 00:17:25.031
And you can, you kind of parse that out a little bit with some of the knee motion. So obviously
00:17:25.112 --> 00:17:29.432
knee flexion, you're gonna probably bias a little bit more of that soleus, and then knee extension, a little more
00:17:29.472 --> 00:17:35.032
gastroc. So first and foremost, just a functional, uh, exam. So, you know,
00:17:35.372 --> 00:17:39.152
walking. Do they have discomfort walking? Do they have discomfort when they go into a crouch
00:17:39.212 --> 00:17:43.012
walk, which is potentially gonna load that soleus a little bit more 'cause they're in a
00:17:43.052 --> 00:17:47.512
kind of a knee flex- Right ... position. Mm-hmm. Um, can they go, can they walk on their toes? So
00:17:47.692 --> 00:17:49.952
can they or can they, can they not, and then what's the quality
00:17:50.012 --> 00:17:53.052
if they can? Um, and then do they have discomfort with any
00:17:53.112 --> 00:17:57.052
of this? Uh, what's their ability to complete a knee to wall test?
00:17:57.212 --> 00:18:00.032
So, uh, loaded dorsiflexion test with, with
00:18:00.112 --> 00:18:03.012
knee flexion, um, and do they feel discomfort
00:18:03.072 --> 00:18:06.092
with that? Uh, palpation, do they have any
00:18:06.212 --> 00:18:07.992
type of pal- palpable,
00:18:08.152 --> 00:18:09.182
uh, deformity?
00:18:09.512 --> 00:18:13.212
Is there anything, is there anything there? Is it local or is it more global? If it's more global
00:18:13.332 --> 00:18:15.032
you might think, um,
00:18:15.392 --> 00:18:20.952
you know, possibly more of just cramping or just general fatigue versus, you know, a very localized, um,
00:18:21.092 --> 00:18:24.052
discomfort. You know, maybe potentially more of an
00:18:24.092 --> 00:18:29.032
injury. Um, and then that exam is gonna really lead you... And then subjective as well, so
00:18:29.072 --> 00:18:31.032
what they were doing when they felt it. Right. Have they had any
00:18:31.052 --> 00:18:37.192
prior kind of symptoms with it, um, or is it just, you know, they acutely were-... taken that false
00:18:37.272 --> 00:18:40.032
step and they accelerated out of it, and boom, they felt their calf.
00:18:40.112 --> 00:18:45.972
So, um, after that whole exam, you know, I think that's when you'd probably progress into, into imaging if
00:18:46.052 --> 00:18:51.192
you, you know, really wanna assess kind of that, that severity and, and what you're actually working with. Um,
00:18:51.612 --> 00:18:55.092
you know, even specifically with a calf injury, there's a lot of just different dynamics
00:18:55.112 --> 00:18:56.932
that you're gonna find. Again,
00:18:57.032 --> 00:19:03.012
the, which injury it is, where along that injury, if it's mid-belly versus more tenderness involvement. Mm-hmm. Um,
00:19:03.402 --> 00:19:08.112
and then, you know, medial or lateral, 'cause you're gonna load those differently as well. So just, there's a lot
00:19:08.132 --> 00:19:10.112
of factors, um, and the imaging can play
00:19:10.172 --> 00:19:17.032
a good role in that. Yeah. And then you're going back and watching the replay, maybe watching the actual mechanism
00:19:17.052 --> 00:19:22.452
of injury as well. Absolutely. Yep, watch the replay, watch the whole process. Is it, again, is it a specific
00:19:22.512 --> 00:19:27.512
movement, um, or is it just general fatigue throughout the game and all of a sudden it got to the
00:19:27.532 --> 00:19:30.232
point where the athlete just reports significant tightness
00:19:30.312 --> 00:19:32.272
by the end? That's,
00:19:32.312 --> 00:19:34.112
that's actually pretty common in some of the calf
00:19:34.152 --> 00:19:37.992
injuries, specifically soleus. Um, you know, it, it does, it
00:19:38.032 --> 00:19:40.232
can be a mechanism itself, is just
00:19:40.932 --> 00:19:42.092
fatigue throughout the game and,
00:19:42.752 --> 00:19:46.972
um, sort of feeling it on one side more than the other, no specific mechanism, and then, you know,
00:19:47.012 --> 00:19:48.932
it turns out to be something a couple of days later.
00:19:49.092 --> 00:19:52.962
So, um, yeah. Trying to see if there's a mechanism, but there isn't
00:19:53.012 --> 00:19:55.032
always one. And does the
00:19:55.132 --> 00:20:01.202
mechanism of injury end up becoming, like, this end goal for you, right, in the end? Where it's
00:20:01.202 --> 00:20:04.032
this is what we have to get them back to. Remember you had the image of the mountain up there,
00:20:04.052 --> 00:20:08.902
and it's like, are you gonna hike this without knowing what you're gonna be trying to do at the end,
00:20:08.972 --> 00:20:15.742
right? For sure. I think it's, um, I think it's always funny. People always say, "Oh, you know, we gotta
00:20:15.752 --> 00:20:21.272
protect this athlete against knee valgus," or against this false step maneuver, or whatever it may be, whatever motion
00:20:21.312 --> 00:20:25.162
it is. But in sport, they have to be able to get into any motion,
00:20:25.492 --> 00:20:31.142
um- Right ... whether it's a crazy position of the knee, whether it's a false step maneuver
00:20:31.252 --> 00:20:36.532
where they're in max dorsiflexion and they have to accelerate. So yeah, it has to be one of your goals.
00:20:36.612 --> 00:20:41.262
Um, you know, from a mental standpoint too, a lot of times the athletes will feel when they start getting
00:20:41.292 --> 00:20:47.822
close into that. They, they will very readily note that. Um, so again, there's a mental component, there's a physical
00:20:47.892 --> 00:20:52.012
component, 'cause they have to be able to, you know, do those tasks in game. So for
00:20:52.052 --> 00:20:58.232
sure. Yeah. And definitely, and, uh, again, another appreciation for the, for that mental side and the psychological side
00:20:58.312 --> 00:21:00.992
of getting back to doing what it is they
00:21:01.032 --> 00:21:03.072
did when they got hurt, so. Absolutely. Yeah. Um,
00:21:04.232 --> 00:21:08.141
so then what does the beginning look like, uh, you know, after maybe your tests and your manual tests
00:21:08.152 --> 00:21:12.062
and all the things that you just listed? Like phase one, what are these early types of movements that you're
00:21:12.072 --> 00:21:13.962
doing, exercises that you'd be focusing on,
00:21:14.012 --> 00:21:18.072
if any? Yeah, absolutely. So the initial stage is
00:21:18.112 --> 00:21:19.252
pretty, pretty,
00:21:19.392 --> 00:21:19.692
um,
00:21:20.572 --> 00:21:20.732
kind of
00:21:21.052 --> 00:21:21.682
boring for,
00:21:22.192 --> 00:21:28.252
for, uh, lack of a better terminology. But it's, it's just, you're try- It's a constant reassessment.
00:21:28.392 --> 00:21:33.052
So, you know, first you wanna find that tolerance of their ability to,
00:21:33.952 --> 00:21:39.012
again, are they, are they walking with some discomfort? Is it manageable? Do they com- uh,
00:21:39.052 --> 00:21:43.532
do they have a compensatory mechanism? And if so, you might want to figure out a way to unload them
00:21:43.572 --> 00:21:45.892
a little bit more, or offload them a little bit more, maybe in a
00:21:46.012 --> 00:21:50.682
boot. Uh, maybe with a heel lift in the shoe. That can be a way to still get them walking,
00:21:50.772 --> 00:21:56.092
but take a little bit of pressure into that, um, you know, away from that calf. Mm-hmm.
00:21:56.192 --> 00:22:00.172
Uh, so that's kind of a reassessment every day, is just try to normalize walking as soon as possible.
00:22:00.772 --> 00:22:01.282
And then,
00:22:01.632 --> 00:22:01.882
um,
00:22:02.252 --> 00:22:07.312
you know, continual reassessment of some of their range of motion. And just, essentially the first stage is allowing
00:22:07.352 --> 00:22:11.192
the tissue to calm down without pro- providing too much kind of input
00:22:11.292 --> 00:22:12.892
into it, and then it's just
00:22:13.012 --> 00:22:19.652
reassessments are very, very common. So, or very, very frequent. So each day, ch- recheck their knee to wall. How
00:22:19.752 --> 00:22:22.162
is their stretch tolerance? How is their walking- Right ... or gait?
00:22:22.912 --> 00:22:27.112
Um, if they have swelling, it's har- kind of hard to see in a calf, but if they have swelling,
00:22:27.172 --> 00:22:28.072
what does that look like?
00:22:28.772 --> 00:22:32.932
And then, again, just kind of normalization of, of ADLs are important at this phase. So it's not
00:22:33.012 --> 00:22:37.072
like you're doing too much. Um, you know, it's not like you're doing calf raises
00:22:37.152 --> 00:22:40.032
day one. Right. There are some ways to also see,
00:22:40.112 --> 00:22:45.052
though. Some people might. Like, some people, it depends on, depends on where they're, again, how severe
00:22:45.072 --> 00:22:46.032
or how mild it is.
00:22:46.332 --> 00:22:47.092
Um, you know, something
00:22:47.112 --> 00:22:51.292
that we do and that I think is pretty helpful is kind of pain threshold
00:22:51.352 --> 00:22:53.032
loading. So it's,
00:22:53.592 --> 00:22:56.091
you know, put the athlete on a seated force plate and
00:22:56.432 --> 00:23:00.952
get them to just produce the most amount of force that they're comfortable. And, and I would, you know,
00:23:01.032 --> 00:23:05.112
cue pretty heavily, like, "All right, I want a less than three out of 10, and I just want
00:23:05.152 --> 00:23:07.092
you to, whatever's comfortable. This is not a test,"
00:23:07.232 --> 00:23:07.992
or, "This is not a,
00:23:08.312 --> 00:23:11.832
um, you know, a, a reward. You don't get a reward. Just, just put whatever..."
00:23:12.092 --> 00:23:16.372
And then whatever they put, that's a pretty good way to assess from day to day too. It creates some
00:23:16.432 --> 00:23:17.412
objectivity into,
00:23:18.072 --> 00:23:22.372
all right, what are they, you know, able to produce- Right ... from a load standpoint. And then that'll help
00:23:22.392 --> 00:23:25.452
dictate too of, all right, they're only able to produce,
00:23:25.852 --> 00:23:26.992
you know, 200 newtons, which
00:23:27.032 --> 00:23:32.052
is very, very low, but they're walking, so d- how does that correlate? And just trying to kind
00:23:32.092 --> 00:23:34.031
of piece it all together in that initial stage.
00:23:35.072 --> 00:23:37.032
Yeah. We had, we had Derek Henson on,
00:23:37.132 --> 00:23:40.992
uh, an episode, and he was talking about running, and obviously we were talking about hamstring pulls, and he's been
00:23:41.012 --> 00:23:45.812
pretty vocal about that and sharing resources about that. And he's saying, hey, like, step one is what can they
00:23:45.852 --> 00:23:51.162
do? Like, forget about what they can't do maybe for a moment. For sure. Um, and that's my words and
00:23:51.162 --> 00:23:55.012
not his, but, you know, forget about what they can't do and, and start focusing on maybe
00:23:55.052 --> 00:24:00.252
what they can do so we can get them moving back to, you know, performance as soon as possible. So
00:24:00.412 --> 00:24:04.992
a question to you is, uh, before we kind of head into phase two, is what's something a practitioner can
00:24:05.112 --> 00:24:08.332
do early on to ensure that they give athlete the best,
00:24:09.072 --> 00:24:09.272
um,
00:24:09.752 --> 00:24:14.112
a- and fastest, most effective chance to return to performance as soon as possible? Is it
00:24:14.472 --> 00:24:16.132
early loading to, to tolerance?
00:24:17.472 --> 00:24:22.062
I think that's really important. I think the, um, again, finding the fine line of not pushing
00:24:22.132 --> 00:24:27.752
too much or not being too aggressive, but at the same time, a lot, like, if they are pain-free walking,
00:24:28.012 --> 00:24:31.952
or when they get to the moment they get to pain-free walking, then allow them to walk, and allow them
00:24:32.012 --> 00:24:36.192
to build some capacity through that. Because even that little loading early
00:24:36.312 --> 00:24:41.932
on can be, again, it's that mechanical transduction. Like, you want load to the tissue. That helps to restore it,
00:24:41.992 --> 00:24:43.212
that helps to, to,
00:24:43.972 --> 00:24:51.064
um, repair it. And so-But just finding the happy medium of not too much load to just create or prolong
00:24:51.084 --> 00:24:54.984
that inflammatory process, and enough load where you're starting to add
00:24:55.044 --> 00:24:55.904
some input into it.
00:24:56.244 --> 00:25:00.134
Um, so it's a hard, it's a hard way to answer the question without- Yeah ... seeing
00:25:00.504 --> 00:25:01.164
calf and front,
00:25:01.244 --> 00:25:06.774
but, but I think - Sure ... just so early on, just being very, very objective with your assessments, and
00:25:06.804 --> 00:25:14.564
then again, don't be afraid to push them to that tolerance, whatever that tolerance is. Whatever that tolerance is, um,
00:25:14.624 --> 00:25:14.774
is
00:25:14.784 --> 00:25:18.284
big. Yeah. It's a quick opportunity for reflection, and I'm curious,
00:25:18.664 --> 00:25:18.704
i-
00:25:19.044 --> 00:25:19.334
early
00:25:19.424 --> 00:25:22.044
days, maybe early in the Magic or just early on, Maggie,
00:25:22.604 --> 00:25:24.934
um, do you find yourself being more, now, in a s-
00:25:25.124 --> 00:25:30.004
within reason, more aggressive now with some of the rehabs? Like early on it was like, "Okay,
00:25:30.124 --> 00:25:33.674
I just don't want to do anything. Let's put them in a boot and make sure they're feeling better," and
00:25:33.724 --> 00:25:37.384
have you found yourself becoming more aggressive, uh- Absolutely ... early on? Yeah, absolutely.
00:25:37.704 --> 00:25:38.104
Um,
00:25:38.624 --> 00:25:38.964
yeah, and at
00:25:39.024 --> 00:25:43.304
times probably, you know, it's just on both ends. Like at times,
00:25:43.704 --> 00:25:45.984
you know, I, I kind of reflect and look back and, all right, maybe
00:25:46.044 --> 00:25:50.004
we should have put them in a boot for a couple days because they were having mild discomfort. It prolonged
00:25:50.024 --> 00:25:54.574
the pro- you know, just i- in both ways, like being... I guess the more assessments,
00:25:55.144 --> 00:25:59.364
um, is where I've kind of turned to, versus before just kind of trying
00:25:59.464 --> 00:26:04.364
to maybe predict when they would be ready to be out of the boot instead of really using the objective
00:26:04.374 --> 00:26:06.124
and the subjective to, to kind of guide
00:26:06.164 --> 00:26:06.884
that process.
00:26:07.244 --> 00:26:08.004
Um- Right.
00:26:08.384 --> 00:26:08.454
Right
00:26:08.464 --> 00:26:08.944
... and so,
00:26:09.344 --> 00:26:14.524
you know, I think, like for example, if they're reporting mild tightness while they're walking and you have them walk,
00:26:14.624 --> 00:26:19.524
you have them in a heel lift shoe and they're pretty much pain-free to walk, and the next day they
00:26:19.584 --> 00:26:23.754
come in and their knee to wall is improved, their pain threshold loading is improved. All right. Well, we might
00:26:23.804 --> 00:26:25.064
be able to ramp it up just a little
00:26:25.084 --> 00:26:27.924
bit then. What, maybe we take, maybe we take one of the heel lifts
00:26:28.004 --> 00:26:28.904
out. Maybe we,
00:26:29.584 --> 00:26:34.064
um, you know, progress the speed of walking, whatever it may be, and then just continue to keep
00:26:34.124 --> 00:26:38.004
a really, really close eye on those assessments to make sure they are tolerating what you're throwing at them
00:26:38.064 --> 00:26:43.084
and, and then using that as a guide instead of just, again, trying to, oh, they're in a boot
00:26:43.144 --> 00:26:44.004
for five days.
00:26:44.344 --> 00:26:45.024
Like, you know-
00:26:45.104 --> 00:26:47.164
Right ... it's, it shouldn't be, it shouldn't be,
00:26:47.964 --> 00:26:50.104
I think early on especially, time-based. It should be,
00:26:50.964 --> 00:26:51.324
um,
00:26:52.144 --> 00:26:53.024
you know, just, just,
00:26:53.484 --> 00:26:53.664
yes,
00:26:54.303 --> 00:26:58.984
function-based, I guess so. Yeah. And you made mention of those early tests, uh, force
00:26:59.024 --> 00:27:02.904
plates with the calf, and then, hey, how much can you press down? And, and using objective data to help
00:27:02.924 --> 00:27:08.824
guide those decisions, um, in addition to some of the subjective stuff that you're feeling. So- Okay
00:27:09.024 --> 00:27:12.024
... thank you for hitting on that. When we move on to
00:27:12.064 --> 00:27:14.084
phase two now, uh, of this right,
00:27:14.764 --> 00:27:15.204
you know, mild
00:27:15.244 --> 00:27:19.304
calf strain, what would we likely be seeing from the athlete
00:27:19.384 --> 00:27:21.034
on the court, in
00:27:21.064 --> 00:27:22.984
the weight room, and
00:27:23.044 --> 00:27:29.024
then from medical? Yeah. So from medical, just continual, uh, reassessment, so
00:27:29.064 --> 00:27:36.104
starting to get assessments for strength, so s- continuing that pain threshold loading on the force plate. Um,
00:27:36.144 --> 00:27:38.364
you know, and being able to track that really closely.
00:27:39.424 --> 00:27:40.884
Low-level early locomotion,
00:27:41.064 --> 00:27:47.364
so, you know, walking in all vectors, um, being able to, you know, see how the calf tolerates
00:27:48.704 --> 00:27:56.264
sagittal, lateral, uh, or frontal and transverse plane motions. Um, a- again, even, even early on locomotion where you're starting
00:27:56.324 --> 00:28:01.164
to just modulate s- various things such as the speed of walking, the direction of walking.
00:28:01.864 --> 00:28:02.384
Um,
00:28:03.044 --> 00:28:03.974
you know, and then, and
00:28:04.024 --> 00:28:06.944
then that would kind of be medically driven. And then
00:28:07.004 --> 00:28:13.324
in the weight room, starting to ramp back up into normal weightlifting activities. So, and u- using that affected side.
00:28:13.444 --> 00:28:15.373
Uh, if you think about the calf specifically,
00:28:15.784 --> 00:28:20.304
you know, people always think, okay, well, you just have to stay away from calf raises or whatever, but,
00:28:20.364 --> 00:28:26.904
you know, even knee dominant exercises are gonna load that, that soleus or that gastroc, more soleus, um, you know,
00:28:26.944 --> 00:28:27.164
top
00:28:27.204 --> 00:28:34.084
down. And so- Mm ... starting to reintroduce, yeah, heavier, you know, knee dominant exercises where, again, you're getting
00:28:34.124 --> 00:28:34.944
that, you're getting that
00:28:35.004 --> 00:28:40.164
input from the top, uh, as well as, you know, exercises, calf raise,
00:28:40.464 --> 00:28:43.164
um, whether it's isometric or, or isotonic.
00:28:43.784 --> 00:28:44.224
Um,
00:28:44.544 --> 00:28:45.944
and then as the phase continues
00:28:46.044 --> 00:28:52.024
on, starting to, uh, to play around with the mode of contraction, so eccentric versus concentric.
00:28:52.664 --> 00:28:52.894
Um,
00:28:53.284 --> 00:28:57.894
again, the angle, so, you know, early on you're in a little bit more of a protected range usually,
00:28:58.004 --> 00:29:03.014
so a little less dorsiflexion, a little less stretch to that tissue. And then as you, as you progress throughout
00:29:03.064 --> 00:29:08.504
that phase, starting to be able to, uh, put them into maybe a little bit more of a biased dorsiflexion
00:29:08.524 --> 00:29:14.174
position. Um, I like to, during this phase, I like to start to add a little bit of
00:29:14.184 --> 00:29:17.984
kind of pulsing to it, so you're adding a little rate of force development, but you're not actually leaving the
00:29:18.004 --> 00:29:20.574
ground, so not- Got it ... not quite a plyometric.
00:29:21.124 --> 00:29:26.014
Um, but, you know, kind of adding some speed to it and starting to, to add that, uh,
00:29:26.064 --> 00:29:26.174
add
00:29:26.204 --> 00:29:29.044
that factor in. And then on court, it depends. I mean,
00:29:29.464 --> 00:29:31.984
it's such a fluid process. It's not like, all right, phase two is
00:29:32.024 --> 00:29:36.014
here, and before phase two you're not doing any jump shooting. And, um,
00:29:36.444 --> 00:29:41.104
typically it's more form shooting, uh, walking, ball handling. Again, ball handling is one
00:29:41.164 --> 00:29:41.344
that,
00:29:42.244 --> 00:29:46.964
uh, that was... I didn't even think about the fact that ball handling, 'cause you're constantly in that knee flexion
00:29:47.044 --> 00:29:48.044
position and you're just moving
00:29:48.084 --> 00:29:50.124
in and out of it, early on, like, that can get
00:29:50.164 --> 00:29:55.984
people. And so that's usually introduced at this phase too where, you know, you're, you're doing some pretty aggressive ball
00:29:56.024 --> 00:30:03.974
handling. You're doing it with motion now. You're walking forward. You're, um, the form shooting, maybe light jump shots right
00:30:04.004 --> 00:30:08.864
around the basket, double leg. Um, you know- Mm ... and then being, if, if you've done that in the
00:30:08.884 --> 00:30:14.074
weight room as well, but, you know, and then starting to introduce that as well. Yeah. I was thinking about
00:30:14.104 --> 00:30:18.304
the ball handling and the pulsing nature of that. I mean, that, that gets a lot, especially on the pounds,
00:30:18.544 --> 00:30:21.864
like y- you're getting that up and down with the flat foot, um- Yeah ... sort of, uh- And then
00:30:21.904 --> 00:30:26.004
you start to, you know, you start to, if you have two balls, you start to move, um, one ball
00:30:26.064 --> 00:30:29.104
forward, the other one back, and so you're just driving in and out of that knee flexion
00:30:29.184 --> 00:30:34.004
position. And again, that, that, you know, does affect the, the calf. And so
00:30:34.504 --> 00:30:35.984
it's just interesting. I've had guys, you
00:30:36.024 --> 00:30:41.544
know, complain about that, you know, n- discomfort during ball handling early on, and, and it was a pretty big
00:30:41.584 --> 00:30:46.614
limiting factor. Other guys, not as much. So again, depends on, you know, which area of the calf we're working
00:30:46.644 --> 00:30:52.914
with and, and, you know, everything. But, um, but that's usually, you know, this phase or, or even the e-
00:30:52.944 --> 00:30:56.014
you know, kind of u- usually in the second phase you, you start to introduce some
00:30:56.044 --> 00:31:03.550
of those. Right. So you mentioned rate of force development earlier and some objective measures. Are there certain benchmarks or
00:31:03.660 --> 00:31:09.740
normative standards that you have for strength, and it could be specific to athlete or maybe team wide or position
00:31:09.760 --> 00:31:10.140
or depending
00:31:10.180 --> 00:31:12.960
on body weight, um, or maybe some relative, you know,
00:31:13.020 --> 00:31:18.080
strength and power numbers. Do you have those? Are those things that you do, you know, you capture during assessments
00:31:18.090 --> 00:31:20.040
early on to see where an athlete was
00:31:20.080 --> 00:31:25.060
prior to injury? Um, and then is that something that you continue to monitor and kind of compare that athlete
00:31:25.120 --> 00:31:28.180
against over time? Absolutely, yeah.
00:31:28.320 --> 00:31:32.180
So we, we try to get baseline on everyone, specifically with calf
00:31:32.260 --> 00:31:32.780
strength.
00:31:33.120 --> 00:31:33.620
Um,
00:31:34.640 --> 00:31:38.980
we haven't gotten everybody, I would say, but we've ha- we have a majority of the guys that we,
00:31:39.160 --> 00:31:43.960
that we have some good calf strength numbers. And so if you look at a lot of the literature,
00:31:44.000 --> 00:31:46.120
it kind of goes anywhere from 1.5 to two times
00:31:46.160 --> 00:31:51.020
body weight. Um, a lot of that literature is in like AFL or
00:31:51.080 --> 00:31:51.720
in rugby,
00:31:52.320 --> 00:31:56.040
where, I don't know how familiar you are with the sport, but they're oftentimes in that kind of scrum
00:31:56.100 --> 00:32:01.080
position, so they're in a really, really deep dorsiflexion position. Yeah. And then they're producing a lot of heavy
00:32:01.120 --> 00:32:02.030
force against, you know,
00:32:02.060 --> 00:32:08.800
another human. Uh, so it's... They probably require a little bit higher demand from the calf than basketball. Um,
00:32:09.080 --> 00:32:12.180
but I still think we, we like to still look at that 1.5 to two
00:32:12.780 --> 00:32:14.980
times body weight and get somewhere in between there,
00:32:15.120 --> 00:32:20.010
um, on like a seated soleus exam. And then for s- for standing calf, I usually say one times
00:32:20.100 --> 00:32:21.020
body weight. So,
00:32:21.840 --> 00:32:22.300
um,
00:32:22.740 --> 00:32:27.050
you know, whether it's like standing on a, on a Smith Machine or, you know, and, and
00:32:27.140 --> 00:32:27.850
able to load it,
00:32:28.040 --> 00:32:30.980
so one times body weight additional. Um, and then you try
00:32:31.000 --> 00:32:34.000
to load it and see, um, you know, for reps as
00:32:34.040 --> 00:32:39.880
well. So, um, those are some of the, some of the kind of benchmarks that we use for, for calf
00:32:39.900 --> 00:32:40.200
strength,
00:32:40.280 --> 00:32:43.000
for sure. And then from a power perspective, you know,
00:32:43.060 --> 00:32:49.960
we look at, we, we do baseline CMJ, single leg CMJ drop. Um, you know, we have some specific to
00:32:49.980 --> 00:32:52.260
calf, so more of like single leg hopping,
00:32:53.160 --> 00:32:56.450
um, for time or for, for r- you know, repetition.
00:32:56.920 --> 00:32:57.000
And
00:32:57.060 --> 00:33:02.100
then, um, you know, comparing to their baseline, comparing to other athletes, and then comparing to their contralateral
00:33:02.110 --> 00:33:04.040
limb too is kind of how we look at it.
00:33:05.200 --> 00:33:08.010
Got it. So then there's your baseline for, hey, over time, okay,
00:33:08.120 --> 00:33:11.970
injury occurs, let's see where they were previously, or have a rough idea of where they were
00:33:12.060 --> 00:33:13.000
maybe at the beginning of the season. Is
00:33:13.020 --> 00:33:17.900
there a, um, frequency to that? Does it also occur in season? Are you gonna retest those things? I imagine
00:33:17.960 --> 00:33:22.050
sometimes it's kind of difficult to find the time in season, but is that something that's happening quarterly? Is it
00:33:22.100 --> 00:33:25.330
happening, you know, biannually? How often are you trying to collect those assessments?
00:33:26.300 --> 00:33:28.000
Yeah. So we, we try to do it ab- about every
00:33:28.020 --> 00:33:28.460
six weeks.
00:33:29.120 --> 00:33:36.040
Okay, cool. So, yep, calf, with calf and, um, a couple other areas. But we try to do, we try
00:33:36.060 --> 00:33:40.370
to do about six weeks, but- Cool. Not perfect. So, quite frequently, actually. You're, you're- Yeah ... getting some pretty
00:33:40.380 --> 00:33:41.000
good data on, on
00:33:41.040 --> 00:33:42.540
these guys. Yep.
00:33:42.600 --> 00:33:47.040
Yep. So, and it's been, it's been really instrumental in just helping us program if we
00:33:47.060 --> 00:33:52.280
find things that are, you know, changing over time or not where we need them to be and, and it's,
00:33:52.320 --> 00:33:57.630
it's been, it's been a helpful kind of protocol. Huge. And then I imagine if an injury does happen, then
00:33:57.680 --> 00:34:00.010
it's, it's really easy to take that athlete and say, "Hey, this is why we did
00:34:00.060 --> 00:34:05.060
all this." Absolutely. Yeah. Yep. It's really, really helpful when, with return to play to have any of the baseline
00:34:05.080 --> 00:34:07.090
numbers, and the more data you have the better
00:34:07.120 --> 00:34:09.980
you're able to stay objective in the process. So it's, it's really
00:34:10.000 --> 00:34:10.300
helpful.
00:34:11.780 --> 00:34:11.980
Okay.
00:34:12.340 --> 00:34:13.340
So continuing
00:34:13.420 --> 00:34:13.600
on,
00:34:14.000 --> 00:34:16.260
um, when we get to phase three,
00:34:17.000 --> 00:34:21.060
I recall you had this list of, like, movement capacity variables that you called it.
00:34:21.100 --> 00:34:24.100
Mm-hmm. Can you touch on what those are and the importance of them?
00:34:25.699 --> 00:34:26.020
Absolutely.
00:34:26.139 --> 00:34:26.440
So,
00:34:27.219 --> 00:34:30.179
um, yes. So I think you're referring
00:34:30.280 --> 00:34:35.920
to, like, the slide that was about duration, load, uh, distance.
00:34:36.100 --> 00:34:38.909
Correct? Yeah. All of these different- Yeah ... factors that were just- Yeah ...
00:34:39.199 --> 00:34:46.600
you know. Yeah. Yeah. So with anything, um, you know, there's, there's strategies that can apply more or less load
00:34:46.620 --> 00:34:50.870
depending on what your goal is. So, you know, if you have that good framework on,
00:34:51.100 --> 00:34:53.080
you know, where I want to be at this time frame of
00:34:53.120 --> 00:34:55.120
rehab, or what goal I want
00:34:55.440 --> 00:34:55.489
the,
00:34:55.820 --> 00:34:57.240
the calf or whatever injury we're referring
00:34:57.280 --> 00:34:57.429
to,
00:34:58.240 --> 00:35:02.200
um, then you can kind of use some of these, these variables.
00:35:02.260 --> 00:35:05.190
So I think some, so some of them are,
00:35:05.320 --> 00:35:06.000
um, speed
00:35:06.040 --> 00:35:06.980
of loading, so
00:35:07.000 --> 00:35:11.040
the rate of loading. Mm-hmm. Uh, the distance that you're loading or the distance that you're potentially
00:35:11.180 --> 00:35:14.260
reaching, the amount of load that you're using.
00:35:14.600 --> 00:35:15.020
Um,
00:35:16.239 --> 00:35:20.090
uh, duration of load, so more volume based. So there's, there's
00:35:20.120 --> 00:35:23.900
just a lot. Um, environment. So whether it's, you know, you're loading
00:35:24.000 --> 00:35:25.140
in, in
00:35:25.520 --> 00:35:25.740
a,
00:35:26.220 --> 00:35:26.460
um,
00:35:26.980 --> 00:35:33.200
you know, chaotic environment versus with react- some reactivity versus, you know, a very controlled environment. Uh, and then obviously
00:35:33.360 --> 00:35:35.020
as you progress throughout the rehab, you're
00:35:35.040 --> 00:35:40.260
gonna be able to kind of play around with which variables you want to focus more on and, and maybe
00:35:40.340 --> 00:35:43.080
focus less on depending on what the goals are during that time. But
00:35:43.540 --> 00:35:47.970
definitely. Yeah. So if we... Yeah, it does. And if we were to think about
00:35:48.060 --> 00:35:53.970
maybe a couple of exercises, and for people listening, they can maybe close their eyes and try to imagine what
00:35:54.000 --> 00:35:58.910
this exercise looked like, if you could be descriptive towards it. Um, maybe one or two exercises that you would
00:35:58.940 --> 00:36:00.010
see during this phase for
00:36:00.040 --> 00:36:07.629
the athlete. For sure. So, you know, at this phase, you're... So we'll, we'll start in the weight room, but,
00:36:07.660 --> 00:36:12.400
you know, this is where you, you asked earlier about kind of that mechanism of injury and, and when you
00:36:12.460 --> 00:36:18.710
possibly, you know, reintroduce it. Um, I think this is where you can use some of those variables to start
00:36:18.740 --> 00:36:23.900
to reinter- reintegrate it, and then be able to modulate the variables depending on how much load you want that
00:36:23.940 --> 00:36:24.140
tissue
00:36:24.160 --> 00:36:28.080
to go through. So this is, you know, in the weight room, it's you're doing
00:36:28.120 --> 00:36:34.390
half, heavy calf loading, you're doing plyometric activity in all the vectors. So again, the sagittal, frontal, transverse.
00:36:35.100 --> 00:36:38.140
Um, all the different angles of the, of the Achilles
00:36:38.500 --> 00:36:39.060
or of the,
00:36:39.120 --> 00:36:44.120
of the ankle, um, dorsiflexion or plantar flexion. Uh, whole body loading. So,
00:36:44.440 --> 00:36:48.040
you know, various examples would be, um, single leg pogo jumps,
00:36:48.460 --> 00:36:50.140
you know, or single, double leg,
00:36:50.260 --> 00:36:56.160
um, jump rope to maybe warm up, and then heavy calf loading throughout the workout, and then maybe something
00:36:56.180 --> 00:37:01.920
where you're going from like a flexed position into that triple extension and you're having to really load your calf
00:37:01.940 --> 00:37:03.032
throughoutThroughout that
00:37:03.092 --> 00:37:03.552
motion.
00:37:04.192 --> 00:37:06.392
Um, and then just progressing
00:37:06.532 --> 00:37:08.992
the, some of the end phase of
00:37:09.032 --> 00:37:12.012
the strength, so the, the power, the rate of force development,
00:37:12.692 --> 00:37:16.372
and whether that's, you know, assisted plyometrics to start progressing
00:37:16.432 --> 00:37:17.912
into- Right ... you know, more of
00:37:18.032 --> 00:37:19.072
the, um,
00:37:19.752 --> 00:37:24.332
from double leg to single leg with less assistant, with actual load, from a height.
00:37:25.232 --> 00:37:25.652
Um,
00:37:25.992 --> 00:37:28.062
so that's what you're gonna kinda see in this phase. And then
00:37:28.092 --> 00:37:28.752
on court, it's,
00:37:29.512 --> 00:37:34.072
it's, there's kinda, it's kinda twofold. It's from a locomotion standpoint or from a movement standpoint,
00:37:34.872 --> 00:37:35.012
you know,
00:37:35.152 --> 00:37:39.002
are they reintroducing curvilinear running, reintroducing... 'Cause if
00:37:39.012 --> 00:37:41.192
you think about from a calf, or really any tissue,
00:37:41.592 --> 00:37:47.232
you know, curvilinear running is, is very common in basketball obviously. It's very common in every s- team-based sport.
00:37:47.972 --> 00:37:54.072
And it requires just different type of load that goes through that m- muscle, and so that's a big motion.
00:37:54.192 --> 00:37:54.532
Um,
00:37:55.132 --> 00:37:59.112
the reactive kind of XLs and D cells are big.
00:37:59.272 --> 00:38:04.172
Uh, so, you know, trying to really, really find areas that are gonna stress
00:38:04.232 --> 00:38:09.172
that tissue. And again, that would go back to also this false step maneuver or, or whatever the mechanism
00:38:09.232 --> 00:38:11.132
was, and then at this phase kind of introducing
00:38:11.152 --> 00:38:16.392
those on court. And then in addition to that, just trying to progress them into a full player development workout
00:38:16.452 --> 00:38:17.552
with no modification.
00:38:17.692 --> 00:38:20.012
So starting where they're doing spots
00:38:20.052 --> 00:38:24.972
and then they're doing, um, so they're actually jumping, and then progressing them into, you know, like a one dribble
00:38:25.012 --> 00:38:31.142
pull up or some various movements. Um, you know, maybe into the pick and roll kind of actions where now
00:38:31.172 --> 00:38:35.472
they're getting some curvilinear running, they're actually getting maybe a little bit of defense, they're having to react to what
00:38:35.512 --> 00:38:38.932
the other opponent is doing or the other, um, offense, uh, teammate's
00:38:39.032 --> 00:38:44.952
doing. And then just being able to build on that, and then using, you know, really allowing the, the coaching
00:38:45.032 --> 00:38:46.112
staff, the player development
00:38:46.152 --> 00:38:50.112
to be creative, uh, with whatever guidelines that, you know, you, you, you put on.
00:38:50.652 --> 00:38:51.072
Um,
00:38:51.912 --> 00:38:54.212
and yeah, you're pretty much trying to return
00:38:54.232 --> 00:38:56.202
all, you know, basketball
00:38:56.232 --> 00:38:58.072
activities, um,
00:38:58.472 --> 00:38:59.112
outside of
00:38:59.192 --> 00:39:02.172
live play, and just kind of building on that. So
00:39:02.472 --> 00:39:04.152
e- eventually adding contact and,
00:39:04.232 --> 00:39:09.392
and all that. I think a lot of the value in this conversation, why I was excited to talk about
00:39:09.432 --> 00:39:11.972
it, was there's so much, it's overwhelming.
00:39:12.011 --> 00:39:16.612
Like, there's so much what, uh, so many options as to what you can do when an athlete gets injured,
00:39:16.872 --> 00:39:18.992
and there's a lot of ways you can go
00:39:19.032 --> 00:39:19.782
with it. But I think,
00:39:20.332 --> 00:39:21.052
um, this
00:39:21.132 --> 00:39:25.252
really helps simplify that, and I think the system that you alluded to with the phases
00:39:25.812 --> 00:39:27.142
just helps break down,
00:39:27.972 --> 00:39:30.992
here's a really clear, organized way to go through this. Now, you're
00:39:31.012 --> 00:39:32.912
gonna have to have some mobility with each
00:39:33.012 --> 00:39:33.912
one, be willing to,
00:39:34.612 --> 00:39:34.772
um,
00:39:35.252 --> 00:39:41.032
be flexible, uh, with each. But it just kind of like, for me, it really broke down the simplicity in
00:39:41.132 --> 00:39:44.032
this process. Uh, it's not, it's not really complicated.
00:39:44.712 --> 00:39:48.922
Well, and that's the thing, and that's where I think you asked me early on, like, the reflection
00:39:49.052 --> 00:39:50.412
stage of, you know,
00:39:50.452 --> 00:39:56.112
being a young clinician and, um, you know, advancing a little bit, and I think
00:39:56.152 --> 00:40:00.372
that's such a big part of it, is it can be really overwhelming. There's so much to think about, specifically
00:40:00.412 --> 00:40:05.692
when you're working in a team environment because, you know, you're trying to think of the timeline of them returning,
00:40:05.752 --> 00:40:10.892
you're also trying to incorporate basketball and the weight room, and you're collaborating with people, and you're having to articulate
00:40:10.932 --> 00:40:12.072
what you think they need to be
00:40:12.932 --> 00:40:13.932
doing and staying away
00:40:14.032 --> 00:40:18.892
from, and it can be really, really kind of a daunting task. Right. And so I think the more you
00:40:18.932 --> 00:40:23.312
can create a framework, and then the more you can create these assessments and these kind of feedback
00:40:23.352 --> 00:40:26.092
loops of, all right, I'm gonna do this assessment every,
00:40:26.792 --> 00:40:31.992
some assessment every day really throughout the entire return to play. But when, what are my kind of feedback
00:40:32.072 --> 00:40:34.062
loops of, all right, the assessment's not going the
00:40:34.092 --> 00:40:39.172
way it should, how do we turn back and pivot? Or how do we add more? Or, you know, whatever
00:40:39.232 --> 00:40:41.092
modification you need to make. But just
00:40:41.172 --> 00:40:44.252
having, s- trying to stay super objective throughout the whole thing is,
00:40:44.292 --> 00:40:46.952
is just really, really helpful to take away
00:40:47.052 --> 00:40:51.252
some of the fear and anxiety and, and just again, how daunting that task
00:40:51.292 --> 00:40:56.932
can be. Yeah. I worked in baseball as a younger strength and conditioning coach. I worked in baseball, and I
00:40:57.012 --> 00:41:00.292
admittedly was really, really bad at,
00:41:00.392 --> 00:41:01.012
at that
00:41:01.052 --> 00:41:01.932
transition from
00:41:02.412 --> 00:41:08.032
early, you know, protection and getting into the optimal loading for hamstrings. Like, and then moving forward and,
00:41:08.052 --> 00:41:09.092
and progressing an athlete.
00:41:09.532 --> 00:41:09.832
I mean, I,
00:41:10.032 --> 00:41:12.992
I felt like I threw stuff at the wall, and it's like, "Okay, let's see what
00:41:13.032 --> 00:41:14.072
sticks." You know? Like, I could
00:41:14.112 --> 00:41:18.122
do this, I could do that. And it wasn't really until I, you know, with the help of somebody else,
00:41:18.172 --> 00:41:22.072
like, built a framework for it, and I mean, it, it was like
00:41:22.092 --> 00:41:22.752
night and day.
00:41:24.042 --> 00:41:28.312
Right. Yep. Um, which, which was super helpful, and I think I really connected that, I guess, with your presentation,
00:41:28.352 --> 00:41:34.232
was, um, just the simplicity of the system and how it really just sets you up for success.
00:41:34.572 --> 00:41:34.772
Um-
00:41:35.232 --> 00:41:37.032
Absolutely ... you know, you have your nuances here and there, but you have to
00:41:37.072 --> 00:41:40.032
have this in place, you know, in order to be, be good at that.
00:41:40.092 --> 00:41:41.092
So, um-
00:41:41.512 --> 00:41:41.962
Yep
00:41:41.962 --> 00:41:41.962
...
00:41:42.432 --> 00:41:44.152
so maybe
00:41:44.212 --> 00:41:48.272
a tougher question to answer, but I guess you head into four, phase
00:41:48.352 --> 00:41:52.052
four, and you're getting ready to return to per- you know, perform,
00:41:52.712 --> 00:41:57.232
uh, and get back into, let's say, a game. How do you know that a athlete
00:41:57.272 --> 00:41:57.972
is truly ready?
00:42:00.472 --> 00:42:04.232
Yeah. No, I think, uh, a difficult question, but a good one. Um,
00:42:04.692 --> 00:42:05.192
you know, it's,
00:42:05.852 --> 00:42:07.212
uh, my answer's kinda the same
00:42:07.392 --> 00:42:09.052
for what I just kind of touched on,
00:42:09.112 --> 00:42:09.252
is-
00:42:10.032 --> 00:42:16.162
Mm-hmm ... importance of having those feedback loops and objective testing throughout. And so, you know, I think somebody once,
00:42:16.712 --> 00:42:20.952
I'm gonna butcher the quote, but somebody once made it, like something about, you know, return to play testing
00:42:21.012 --> 00:42:26.312
shouldn't be a day. It should be the entire process of your, of your rehab. So you should have
00:42:26.412 --> 00:42:31.472
a really, really good idea if this athlete's ready to return based on every single day being a check mark,
00:42:31.592 --> 00:42:38.212
being a, a point that you, you know, get data and, and what you get from it. And so
00:42:38.272 --> 00:42:42.592
I never really, like, it's never really, like, you get to the... Or you shouldn't, I don't think, ever get
00:42:42.632 --> 00:42:46.592
to the taye of return to play testing and you're like, "I have no idea if this athlete's gonna pass
00:42:46.632 --> 00:42:50.792
or not." Like, you, you have a pretty good idea based on what you've brought them through if you do
00:42:50.832 --> 00:42:53.232
it in a gradual, progressive, progressive overload
00:42:53.332 --> 00:42:57.832
way. Right. Then I think you have a really good idea if this athlete's gonna be ready or not.
00:42:58.092 --> 00:42:59.262
Um, and that means
00:42:59.872 --> 00:43:01.012
from a court perspective,
00:43:01.232 --> 00:43:04.032
you know, we, we try to create this return to play profile pretty
00:43:04.072 --> 00:43:05.162
early on,
00:43:05.912 --> 00:43:09.112
all right, what metrics does this athlete need to get back to? Uh,
00:43:09.152 --> 00:43:14.104
or what do they need to get back to from an on-court perspective?And that's from a basketball perspective. What do
00:43:14.124 --> 00:43:18.044
they need to get back to? What do they need to show they have good tolerance to from a injury
00:43:18.104 --> 00:43:22.024
perspective? Like, what, what metrics or what movements are gonna load that
00:43:22.084 --> 00:43:27.074
tissue? And then how do you marry those two? And then how do you break it down where
00:43:27.104 --> 00:43:30.074
in phase three when you're doing these player development workouts, all right, we're checking
00:43:30.104 --> 00:43:34.064
the box of decelerations, accelerations, whatever it may be,
00:43:34.464 --> 00:43:39.024
um, and really being able to gradually progress them back up. So again, when
00:43:39.064 --> 00:43:40.164
they get to that return to play
00:43:40.324 --> 00:43:46.144
date, you've got a pretty good feel that, all right, their chronic load's good, their acute load is good, their
00:43:46.204 --> 00:43:51.164
ability to tolerate, you know, high intensity actions on court is really good.
00:43:51.284 --> 00:43:57.084
Um, and then same thing with the strength testing, with the power testing. So again, hopefully you've been testing their
00:43:57.164 --> 00:44:03.984
strength enough throughout, and you've been testing their power and rate of force development enough throughout that y- you test
00:44:04.024 --> 00:44:09.164
it early enough that if you need to pivot, you can early. Because if you wait till the end
00:44:09.204 --> 00:44:12.384
to take all those measurements and they're not ready,
00:44:12.504 --> 00:44:16.064
and they wanna be ready, and now all of a sudden you need to pivot and try
00:44:16.103 --> 00:44:22.294
to change some of your strategies, it's too late. And so, especially in pro sports, like time is, time is
00:44:22.324 --> 00:44:24.084
everything. Time is, time is money. So
00:44:24.904 --> 00:44:25.164
you,
00:44:25.724 --> 00:44:28.244
y- you just, the sooner that you can start to gain these assessments,
00:44:28.324 --> 00:44:28.763
the better.
00:44:29.124 --> 00:44:30.054
Um, and
00:44:30.144 --> 00:44:32.144
so, you know, it's a, it's a long-winded
00:44:32.204 --> 00:44:36.324
answer to say it's super multifactorial. I think you need the, the objective,
00:44:36.684 --> 00:44:37.364
subjective,
00:44:37.664 --> 00:44:41.224
uh, and objective just clinical testing of the athlete's clinically sound.
00:44:41.804 --> 00:44:45.064
Um, strength and power is normalized and back to baseline or,
00:44:45.484 --> 00:44:47.984
you know, s- a- or symmetric compared to their contralateral
00:44:48.064 --> 00:44:52.144
limb. And then their court loads. They've showed tolerance to,
00:44:52.264 --> 00:44:58.344
again, what, you know, which high intensity metrics are gonna bother them more and, um, and then confidence. The athlete's,
00:44:58.404 --> 00:45:01.484
you know, voicing confidence. or showing confidence. So-
00:45:01.564 --> 00:45:01.694
Yeah
00:45:02.604 --> 00:45:02.794
... yeah,
00:45:03.104 --> 00:45:09.584
putting that all together. I appreciate that. I think you said something like 80% of, or, or the rate of
00:45:09.624 --> 00:45:12.204
injury, is 80% higher in the first game back. Mm-hmm.
00:45:12.524 --> 00:45:14.864
Is, is that right? So can you tell me about
00:45:15.024 --> 00:45:20.884
your experience, uh, i- in the role you're in watching an athlete maybe take the court again for the first
00:45:20.924 --> 00:45:25.084
time? Is there a nervous feeling? I mean, I know you just spoke to all the things that hopefully give
00:45:25.124 --> 00:45:27.704
you a ton of confidence, but at the end of the day, they have to go back in, and the
00:45:27.744 --> 00:45:28.034
game is
00:45:28.044 --> 00:45:29.184
the game. So
00:45:30.094 --> 00:45:33.204
is there- Absolutely ... is there a nervous feeling always for you, or are you like, "Hey,
00:45:33.244 --> 00:45:34.964
our work is done. I know we've done a good job. Like,
00:45:35.044 --> 00:45:42.774
I'm confident about this"? I'm probably less nervous in a chronic injury that's taken like, that's had time loss where
00:45:42.804 --> 00:45:46.244
you have the whole process of doing it the right way, progressive overload,
00:45:46.304 --> 00:45:48.124
you've taken every metric you can.
00:45:48.524 --> 00:45:50.024
There's still, of course, some anxiety
00:45:50.064 --> 00:45:54.264
'cause you, there should be. You put all your time and equity and sweat and tears
00:45:54.304 --> 00:45:57.214
and, into this athlete and into this injury that
00:45:57.744 --> 00:46:02.624
you have stake in the game. You know, you have, you obviously, you want that athlete to succeed, and so
00:46:02.664 --> 00:46:05.084
there's always fear. Uh, I th- I do
00:46:05.224 --> 00:46:08.034
think the fear and anxiety is probably a little higher if it's
00:46:09.344 --> 00:46:13.954
an injury that you're kind of just managing them through where- Right ... you might not have the
00:46:14.004 --> 00:46:19.164
time to really create all these robust protocols and, and really take the time to go through each of them.
00:46:19.244 --> 00:46:24.964
It's, you know, maybe they miss one game with some hamstring tightness, but it's not, you know, a full on-
00:46:25.004 --> 00:46:25.984
hamstring strain,
00:46:26.064 --> 00:46:31.044
and it's athlete wants to give it a shot and, or in game, they want to return to play, and
00:46:31.404 --> 00:46:34.104
you've tested them in the hallway, and you've, you've assessed it, and it's
00:46:34.664 --> 00:46:39.184
a little gray, but you think they can. That's when, you know, you kind of hold your breath
00:46:39.204 --> 00:46:39.994
and just think, "All
00:46:40.004 --> 00:46:40.133
right,
00:46:41.324 --> 00:46:44.004
you know, hopefully my assessment's just, uh-"
00:46:44.014 --> 00:46:46.164
Yeah ... "w- were spot on and, and that they're ready"
00:46:46.284 --> 00:46:51.004
But it gets less every, you know, every injury, every day. And y- you also get to see the
00:46:51.124 --> 00:46:52.064
athlete too, 'cause,
00:46:53.404 --> 00:46:57.124
you know, it's the positive of working with these athletes every day' is you kinda get to know, the,
00:46:57.624 --> 00:47:02.304
you know, the athlete in front of you. Some are gonna be super aware of everything they feel,
00:47:02.384 --> 00:47:03.964
and you' kinda
00:47:04.024 --> 00:47:08.994
just need to push them along. Some are gonna be really, really robust guys that never complain about things, and
00:47:09.024 --> 00:47:14.394
all of a sudden they complain. You're like, "Ah, okay. Something's going on here." And so- Mm ... you kinda
00:47:14.504 --> 00:47:18.494
get to know, all that too, and, then it just helps to... 'Cause guys are gonna complain about certain things,
00:47:18.544 --> 00:47:23.504
and, their, again, their level of kind of robustness will change depending on the athlete. And so, once you. start
00:47:23.524 --> 00:47:26.284
to get that, it' adds good context on feeling confident
00:47:26.344 --> 00:47:31.024
that they're ready. Totally. Well, thank you for laying all that out. I know it's not always easy to
00:47:31.064 --> 00:47:35.424
do, you know, with audio to be able to describe all of that stuff. I know it's such a hands-on
00:47:35.484 --> 00:47:39.044
experience- Yeah. Yep. ... what you're doing. So I' appreciate you laying all
00:47:39.144 --> 00:47:39.504
that out.
00:47:40.044 --> 00:47:44.004
Um, I listened to another podcast you were on, actually, and I heard you say this line,
00:47:44.214 --> 00:47:46.634
and, and it kinda stuck with me a little bit, so I wanna ask you about it. You said, "Don't
00:47:46.664 --> 00:47:52.034
rush to communicate things. Wait 24 hours, and after that period, you'll know, so much more." Can you expand on
00:47:52.064 --> 00:47:54.844
that? Absolutely. Yeah. I think, uh, you know,
00:47:55.004 --> 00:47:57.904
I give, I give some of my mentors,
00:47:58.124 --> 00:48:00.684
um, credit with this because,
00:48:01.624 --> 00:48:02.984
you know, everything is sped up in, s-
00:48:03.044 --> 00:48:03.624
pro sports,
00:48:04.004 --> 00:48:07.924
and it's a positive and a negative. Like, we have the ability, you have an injury, we have the ability
00:48:07.964 --> 00:48:13.074
to MRI an hour later. Um, and there's a, it's a blessing and a curse because,
00:48:13.104 --> 00:48:14.344
you know, a real world person,
00:48:14.824 --> 00:48:16.064
or just not real world,
00:48:16.224 --> 00:48:18.064
uh, a normal person on the street
00:48:18.484 --> 00:48:22.034
might not get an MRI for, like, two weeks. And so there's time to digest, there's time
00:48:22.064 --> 00:48:29.053
to process, there's time to really assess all the factors and make, you know, an all informed decision. And sometimes
00:48:29.084 --> 00:48:33.784
we get information in bits. You know, the injury occurs. You have kind of that, you have that exam in
00:48:33.804 --> 00:48:38.164
front of you. But you haven't gotten imaging, and the athlete's emotional, and the agent's calling, and our president's
00:48:38.204 --> 00:48:42.974
calling. And just take a breath, slow down. Because the minute you start to give any. type-
00:48:43.024 --> 00:48:45.974
And it kinda goes back to Todd's comment about the alignment of
00:48:46.024 --> 00:48:49.944
messaging, is there's a lot that goes into the importance of controlling
00:48:50.004 --> 00:48:51.344
a message. Um,
00:48:51.704 --> 00:48:54.004
and it's, it oftentimes will
00:48:54.304 --> 00:48:55.324
be much better
00:48:55.704 --> 00:49:00.924
if you just take time to kind of debrief on it, um, assess it,
00:49:01.004 --> 00:49:07.584
and then, you know, communicate at an effective manner instead of trying to rush a diagnosis, rush a prognosis.
00:49:07.624 --> 00:49:09.004
'Cause as you
00:49:09.024 --> 00:49:10.964
know, like, y- we'll get an
00:49:11.004 --> 00:49:18.044
ankle sprain, and a guy can't walk, and it's, it's, looks significant and-They might be a little dramatic, and all
00:49:18.064 --> 00:49:22.244
of a sudden they have, um, you know, this forefoot pain and this medial bony pain
00:49:22.304 --> 00:49:26.004
and, and you're thinking, "Okay, this could be pretty bad." And then, the next day they're
00:49:26.014 --> 00:49:29.014
like, "All right, I'm good to play." So, and that happens
00:49:29.014 --> 00:49:35.844
so much. Um, and I think that's been a huge learning curve too, is how the guys... Uh, emotions, obviously
00:49:35.854 --> 00:49:42.704
very strong in this business, um, especially if it happens in game or something. And so, so often what you
00:49:42.764 --> 00:49:47.044
would have predicted in that moment is not what's gonna happen 24 hours later. And we've learned
00:49:47.104 --> 00:49:50.974
it, and I think we've educated our management staff on that as well, and some of
00:49:51.004 --> 00:49:56.264
the agents of, don't try to guess a diagnosis unless it's pretty dang clear.
00:49:56.564 --> 00:49:58.024
Um, and
00:49:58.384 --> 00:50:01.104
just don't rush that communication. So it's, it's
00:50:01.184 --> 00:50:02.864
a really, really good thing that
00:50:03.044 --> 00:50:07.344
I've learned throughout the way. Yeah, and then you have your avid fans that are rushing
00:50:07.404 --> 00:50:07.664
to
00:50:08.004 --> 00:50:09.184
Twitter or X on,
00:50:09.504 --> 00:50:13.004
you know, "What does pro football doc think about this?" Exactly,
00:50:13.044 --> 00:50:17.864
exactly. So everyone's gonna have an opinion. And we always do it too. Like, you know, an injury occurs in
00:50:17.924 --> 00:50:21.104
game, we're all texting each other, "What do you think it is?" From a different team, you know?
00:50:21.184 --> 00:50:26.034
And so it's natural, but it's, uh, there's just so much that goes into it. And again, the emotion
00:50:26.064 --> 00:50:32.114
of the players and, and all the stakeholders creates this high emotional experience, and it can just...
00:50:32.144 --> 00:50:34.064
It can lead to so much more confusion if you rush
00:50:34.104 --> 00:50:34.264
it,
00:50:34.604 --> 00:50:34.784
so.
00:50:36.364 --> 00:50:38.044
Yeah. I really like that, and, and thanks
00:50:38.064 --> 00:50:41.044
for sharing, um, more about that quote.
00:50:41.124 --> 00:50:44.884
So when you consider the future of rehab, I know, there's a lot of stuff changing,
00:50:45.004 --> 00:50:49.264
uh, i- in our world, what do you think is an area that's maybe underappreciated now,
00:50:49.964 --> 00:50:52.064
or will maybe play a much bigger role than it does
00:50:52.104 --> 00:50:54.984
now, in the area of physical therapy
00:50:55.004 --> 00:50:58.224
and rehab? I think, um,
00:50:58.784 --> 00:51:01.864
you know, and it's already kind of made this shift, I'd say, but I think
00:51:02.004 --> 00:51:09.024
the creating more of a robust athlete. And so more time spent in the weight room, more time spent,
00:51:09.344 --> 00:51:13.844
um, you know, on court and building up their capacity versus the
00:51:14.004 --> 00:51:17.624
kind of old, old standards of rest, mobilize.
00:51:18.344 --> 00:51:20.784
Um, you know, a lot of ph- physical therapy clinics,
00:51:21.084 --> 00:51:24.044
um, you know, historically didn't even have, like don't even have
00:51:24.684 --> 00:51:31.373
gyms. They don't even have weight that goes over 20, 20 pounds. And I'm a firm believer that
00:51:31.604 --> 00:51:35.524
y- you just, need more than that, and you need, you need a system and a process that's gonna be,
00:51:35.664 --> 00:51:41.884
um, you know, creating this robust athlete. And so I think over time, we're even seeing, like, again, more physical
00:51:41.904 --> 00:51:46.004
therapy clinics or more rehab settings are now, pairing up
00:51:46.064 --> 00:51:50.004
with basketball coaches and, pairing up with, uh, strength, you know, with
00:51:50.104 --> 00:51:54.344
gyms and, and they're allowing that athlete to kind of go through the whole gamut versus
00:51:55.044 --> 00:51:59.084
all these modalities and, and kind of passive treatment. So I just think being more aggressive and, and
00:51:59.204 --> 00:52:01.294
being... Not aggressive, but being more,
00:52:02.584 --> 00:52:04.033
um... Yeah, just creating more
00:52:04.044 --> 00:52:06.024
of a robust, robustness with the,
00:52:06.104 --> 00:52:08.504
with the injury, I guess. Yeah, maybe proactive,
00:52:08.804 --> 00:52:09.024
like
00:52:09.104 --> 00:52:09.544
just- Yeah
00:52:10.044 --> 00:52:12.093
... right. Um, makes sense. Makes
00:52:12.144 --> 00:52:16.944
sense. And, um, as you sit back and reflect a little bit, and I imagine you now, meet some younger
00:52:16.964 --> 00:52:19.524
PTs that are, they're getting into it, and with your experience,
00:52:20.024 --> 00:52:21.974
you're being asked, uh, you know, how'd you get to where
00:52:22.004 --> 00:52:22.854
you are, things like that,
00:52:23.524 --> 00:52:25.944
um, any advice that you'd give to
00:52:26.024 --> 00:52:29.024
younger PTs that want to be involved in sports?
00:52:29.684 --> 00:52:30.084
Yeah.
00:52:30.204 --> 00:52:33.224
Um, I think one big thing
00:52:33.324 --> 00:52:37.224
that I often see is people want to rush the process. They wanna,
00:52:38.524 --> 00:52:44.354
they wanna watch a basketball game, see a PT on. the, floor, and they wanna become that person because
00:52:44.384 --> 00:52:49.304
it's so cool. And it is cool, and it's great, but, there's a lot of things that go into it
00:52:49.424 --> 00:52:52.044
that might not be great. Like, you gotta, just don't rush
00:52:52.084 --> 00:52:57.544
the process. Go through... You know, I've had high school students say they want to be an, NBA PT, and,
00:52:57.584 --> 00:52:59.944
it's, you' know, they're not even PTs yet. So
00:53:00.004 --> 00:53:05.044
first and foremost, just don't rush the process. Like, go through every step. Make sure. that's what you want to
00:53:05.104 --> 00:53:12.984
do. Um, don't skip steps, because you need to... You, that framework that PT school or that, you know, early
00:53:13.104 --> 00:53:16.124
on, it, it just, it teaches so much, even if it's not something
00:53:16.184 --> 00:53:22.164
that might, that you might not think directly correlates with the job that your goal, you know, your goal to,
00:53:22.204 --> 00:53:24.034
to get to is. Um,
00:53:24.664 --> 00:53:28.064
you know, having a really robust foundation in neuro, in neuro, neurology,
00:53:28.364 --> 00:53:33.084
um, all of that, it matters, and- it matters in my day-to-day, even though, again,
00:53:33.144 --> 00:53:36.024
I think a lot of people just kind of rush it. They want to do the ortho and sports.
00:53:36.344 --> 00:53:36.584
Um,
00:53:36.943 --> 00:53:37.034
and
00:53:37.063 --> 00:53:40.344
then the other thing is, is just find really good mentorship and,
00:53:40.944 --> 00:53:45.064
you know, lean heavily on those people. And I've, I was super fortunate. I had great mentors
00:53:45.144 --> 00:53:45.984
throughout the, throughout the
00:53:46.024 --> 00:53:50.864
way that just took me under their wing and, and helped me get to where I'm at today. And I
00:53:50.904 --> 00:53:54.044
think, um, young students especially, you know, I think they
00:53:54.104 --> 00:53:56.974
wanna, they wanna just reach out and ask how
00:53:57.004 --> 00:53:59.924
they get to where someone got to or, you know- Right ...
00:54:00.024 --> 00:54:00.054
um,
00:54:00.784 --> 00:54:00.974
but,
00:54:01.424 --> 00:54:02.124
like, learn,
00:54:02.584 --> 00:54:02.924
learn it
00:54:03.024 --> 00:54:07.984
all. Learn, have someone help you throughout the process. Don't just try to skip the step to, to just get
00:54:08.044 --> 00:54:12.143
there, and have someone connect you to somebody else and, you know, just...
00:54:13.064 --> 00:54:13.224
So,
00:54:14.364 --> 00:54:14.564
yeah.
00:54:14.604 --> 00:54:16.124
Yeah. That's, that's great.
00:54:16.504 --> 00:54:17.204
All right, I got some rapid
00:54:17.224 --> 00:54:17.994
fire questions for you-
00:54:18.724 --> 00:54:20.064
Okay ... to finish off here.
00:54:20.824 --> 00:54:25.164
Okay. So if you weren't doing physical therapy, what do you think you'd be doing?
00:54:26.984 --> 00:54:27.644
Um,
00:54:27.944 --> 00:54:30.004
medical device sales or real estate, I think.
00:54:31.824 --> 00:54:32.044
Um,
00:54:32.704 --> 00:54:35.964
favorite player to watch in the NBA that is not on
00:54:36.004 --> 00:54:38.994
the Clippers? Is this
00:54:39.064 --> 00:54:39.944
legal? Uh-
00:54:41.434 --> 00:54:46.124
... Steph Curry. Do you have any pre-game superstitions?
00:54:48.304 --> 00:54:51.924
Um, I split half a Krispy Kreme donut with my
00:54:52.204 --> 00:54:56.224
coworker. We do every pre-game. It's probably not great-
00:54:56.324 --> 00:54:58.044
Have to ... by the end of the year. Have to have
00:54:58.084 --> 00:55:00.284
it. Yeah, yeah, we do. Every game.
00:55:00.344 --> 00:55:03.004
Every game. Favorite city to travel
00:55:03.044 --> 00:55:03.554
to on the road?
00:55:04.624 --> 00:55:07.984
Ooh, I love Boston. I love
00:55:08.004 --> 00:55:11.024
Miami. Boston and Miami. Oh, DC.
00:55:12.224 --> 00:55:13.164
Everybody says those.
00:55:13.664 --> 00:55:16.964
Oh. Like, DC is so... Where we stay in DC, we stay in Georgetown right
00:55:17.004 --> 00:55:22.574
next to the monuments. It's a perfect five-mile run. I run from where we stay in, uh, Boston to Harvard,
00:55:22.624 --> 00:55:27.534
and it's just some... I love the Northeast. And then Miami is great too, so. Right. I was gonna ask,
00:55:27.584 --> 00:55:30.474
so when you have some time on the road, if you're able to find some, I know, it's a lot
00:55:30.504 --> 00:55:33.674
of in and out, like, what do you like to do? Is it going for walks or trying to find
00:55:33.724 --> 00:55:33.974
a place to
00:55:34.004 --> 00:55:35.792
go run? Yeah, for sure. Yep.
00:55:36.052 --> 00:55:41.072
And then, uh, sometimes we'll find, like, kinda local places to eat that, have whatever the local food is
00:55:41.132 --> 00:55:45.682
or just, kinda look at, like, random markets and I don't... I'm not... I go to, bed pre- I, I'm
00:55:45.752 --> 00:55:49.652
a big... I try to get my sleep, so I don't do too much at night, so I try to
00:55:49.692 --> 00:55:50.032
kinda get
00:55:50.052 --> 00:55:52.032
it' in, uh, in the morning, afternoon,
00:55:52.092 --> 00:55:53.092
and then knock
00:55:53.112 --> 00:55:56.012
it out. Right. Get your good meal and go to bed. See
00:55:56.032 --> 00:55:58.022
you tomorrow. Exactly. Yep. Yeah. Yep. I like
00:55:58.072 --> 00:56:01.092
it. Um, all right. So when you have some time off,
00:56:02.092 --> 00:56:02.272
uh,
00:56:02.612 --> 00:56:05.112
what would we' find you doing? What are some of your hobbies? What do you enjoy
00:56:05.132 --> 00:56:08.192
doing? Um, yeah, traveling.
00:56:08.532 --> 00:56:13.032
I think staying super active, so I like to hike, specifically in, uh, in LA I love to find random
00:56:13.052 --> 00:56:16.492
hikes, and I'll just go by myself and, or with friends or... But,
00:56:16.512 --> 00:56:23.752
but, like, hike, uh, be around family, travel. I travel quite a bit in the off-season, so with players or
00:56:23.792 --> 00:56:23.952
just
00:56:24.072 --> 00:56:26.132
personally. So, um,
00:56:26.472 --> 00:56:26.632
yeah.
00:56:27.812 --> 00:56:30.772
All right. Um, Los Angeles food recommendation.
00:56:32.492 --> 00:56:35.012
Ooh, I'm not a big foodie. Uh,
00:56:37.732 --> 00:56:40.112
uh, I might need to skip this one. Oh,
00:56:40.192 --> 00:56:42.972
that's fine. Yeah. All right. And a fol- okay, a follow-up question
00:56:43.032 --> 00:56:44.212
for you then. Um,
00:56:44.492 --> 00:56:45.432
is In-N-Out
00:56:46.032 --> 00:56:46.632
overrated,
00:56:47.412 --> 00:56:48.112
underrated,
00:56:48.492 --> 00:56:49.272
or appropriately
00:56:49.332 --> 00:56:49.672
rated?
00:56:51.272 --> 00:56:54.012
I personally think it's overrated, but a
00:56:54.072 --> 00:56:57.512
lot of people- I agree. I say that. Yeah. A lot of people yell at me. We' do, we do,
00:56:57.612 --> 00:56:59.212
uh, a lot of Chick-fil-A.
00:57:00.432 --> 00:57:06.182
And I know that's chicken, it's not hamburgers usually, but, uh, but, it's delicious. Uh, I would take that
00:57:06.252 --> 00:57:09.992
over In-N-Out Burger. I agree wholeheartedly with you. Oh,
00:57:10.092 --> 00:57:13.192
right. No, that's a debate. All right. We've had this debate a lot.
00:57:14.232 --> 00:57:15.992
Yeah. It's one I have every single time I travel
00:57:16.032 --> 00:57:18.012
to LA. It's- Exactly. As you should
00:57:18.032 --> 00:57:22.172
... I, I, I, I don't understand what the fuss is all about. Um, but- I don't either. I... Yeah.
00:57:22.562 --> 00:57:23.252
I'm, I'm not sold
00:57:23.292 --> 00:57:24.992
on it. All
00:57:25.032 --> 00:57:26.192
right. And then
00:57:26.512 --> 00:57:29.172
last one I have for you, favorite TV show
00:57:29.212 --> 00:57:29.892
to binge watch?
00:57:31.312 --> 00:57:34.632
Ooh. Uh, I really like Suits
00:57:36.192 --> 00:57:37.432
or Grey's Anatomy
00:57:37.492 --> 00:57:40.052
or Billions. I'm watching This Is Us
00:57:40.092 --> 00:57:42.992
right now. So yeah. Oh, is it good? I haven't started that. It's
00:57:43.052 --> 00:57:43.612
actually really good.
00:57:44.012 --> 00:57:46.012
So I'm really bad- Yeah ... I get pretty busy, and I
00:57:46.212 --> 00:57:50.942
tend to just... Like, I'll watch an episode, and then I won't watch again for three weeks. But, uh,
00:57:51.132 --> 00:57:55.372
it's pretty... So this is actually one that you can kinda follow even if you don't follow, like, day to
00:57:55.432 --> 00:57:56.992
day. So it's been good. I
00:57:57.032 --> 00:57:59.062
like it. All
00:57:59.112 --> 00:58:00.072
right. Yeah. So-
00:58:00.112 --> 00:58:04.052
Watch it. All right. Well, I really appreciate it, a- and thank you for your time, and
00:58:04.152 --> 00:58:06.152
thank you for joining me today on the Kaiser Human Performance
00:58:06.212 --> 00:58:11.152
podcast. Definitely wishing you and the Los Angeles Clippers good luck in the NBA playoffs, and we hope
00:58:11.192 --> 00:58:13.332
to see you on TV during the highlights,
00:58:13.972 --> 00:58:17.012
uh, you know, during the highlights of the parade in Los Angeles. I love it. Maybe, uh, maybe
00:58:17.032 --> 00:58:19.332
you'll have two Krispy Kreme donuts. Yeah, exactly.
00:58:19.932 --> 00:58:21.192
I won't know what to do with myself.
00:58:21.782 --> 00:58:25.092
But no, I appreciate it. I appreciate it. Thank you for having me on, and, uh, it's been
00:58:25.172 --> 00:58:26.042
fun. So thank
00:58:26.092 --> 00:58:31.152
you. Of course. And to stay up-to-date on Maggie, you can follow her on X @Bryant5Maggie
00:58:31.712 --> 00:58:36.052
or on Instagram @magsb55. Thank you for listening, and have
00:58:36.092 --> 00:58:47.272
a great day. We appreciate you tuning in to this episode of the Kaiser Human Performance podcast.
00:58:47.892 --> 00:58:49.022
To stay up-to-date on all
00:58:49.052 --> 00:58:51.592
things Kaiser, follow us @KaiserFitness
00:58:51.912 --> 00:58:52.012
on
00:58:52.052 --> 00:58:53.132
Twitter, Instagram,
00:58:53.392 --> 00:58:57.032
and Facebook. For more content, you can visit our Kaiser Fitness
00:58:57.092 --> 00:59:01.492
YouTube page and at our website, www.kaiser.com.
00:59:02.092 --> 00:59:02.272
Thank
00:59:02.332 --> 00:59:03.012
you, and have
00:59:03.032 --> 00:59:03.632
a great day.
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